The WHO officially declares the virus a pandemic, and The DO discusses the situation with a family physician who focuses on infectious diseases.

The novel coronavirus disease (COVID-19) continues to spread domestically and abroad. Here are the latest numbers and information as of 9 a.m. on Wednesday, March 18:

Number of cases in the U.S.: The CDC is reporting 4,226 COVID-19 cases and 75 deaths. The CDC is reporting confirmed and presumptive positive cases of COVID-19 reported to CDC or tested at CDC since Jan. 21, 2020. The New York Times is reporting at least 5,881 cases and 107 deaths in the U.S.

States that have one or more COVID-19 cases, according to the New York Times: All 50 states, three U.S. territories and Washington, DC, have at least one confirmed COVID-19 case.

Global cases: There have been 179,111 confirmed cases worldwide and 7,426 deaths, according to the WHO.

Social distancing nearly ubiquitous: On Monday, President Donald Trump shared recommendations from the CDC calling for Americans to avoid social gatherings of more than 10 people and limit discretionary travel. He said the country should be prepared for the possibility that these restrictions may be necessary into July or August.

Across the country, many cities and states have mandated the closures or partial closures of restaurants, bars and other gathering places. Cities in the Bay Area have instituted shelter-in-place orders, and officials in New York and other cities have expressed plans to follow suit. Operations for most major sports and events worldwide have been halted or postponed until further notice, and many corporate employers have begun mandating working from home.

U.S. government seeks to offset financial burden of virus: On Tuesday, Treasury Secretary Steven Mnuchin said the Trump administration was considering “immediately” sending checks to Americans. Last week, Trump expressed his preference for a payroll tax cut, but Mnuchin said the process would take too long and keep money from reaching Americans’ pockets in a timely manner. He did not reveal how much citizens could expect to receive, but for the time being, he encouraged all who haven’t already to file their personal taxes before the April 15 deadline to ensure they receive their refunds.

Q&A: A family physician who focuses on infectious diseases shares insights

Tom Moorcroft, DO, a family physician who focuses on infectious diseases in Berlin, Connecticut, has been fielding questions nonstop for weeks from patients and media, including CNET, alike.

To assist them, he’s added a new page on his practice’s website that directs visitors to an information guide he’s created on staying safe as well as video and written content he puts out regularly in response to new developments and inquiries.

In this edited interview, Dr. Moorcroft shared his perspective on the COVID-19 pandemic.

How comparable is COVID-19 to SARS, MERS, or influenza?

COVID-19 is far more rapidly progressing and evolving than SARS and MERS. This being a new variation of a coronavirus makes it challenging, since a lot of the answers to questions are “I don’t know.”

The mortality rates of SARS and MERS were much higher, but COVID-19 is spreading more widely than these viruses have. MERS has seasonal variation, and we don’t know if we will be that lucky with this.

It does look a lot like influenza in some respects. One thing influenza and COVID-19 have in common is a latency period. You may get infected, but there’s an incubation period that might be two to 14 days. You may have asymptomatic viral shed, so prior to you being sick, it’s possible that you can transmit it to somebody else. With SARS and MERS, we saw that patients needed to be sick before they could transmit the disease.

What can DOs do to protect themselves and their patients?

Get to know your institution’s infection control policy as soon as possible. Communicate with your patients about the major symptoms (fever, cough, shortness of breath). There’s some new data suggesting that for a week you’d have malaise and muscle aches and a more low-grade fever, before getting into the classic triad of COVID-19.

If patients have any of those symptoms, they should call the office, not come to the office. Some hospitals are setting up drive-through testing sites to reduce risk. Any coughing patient should really have a mask on and be segregated until we know that they need testing.

Everybody’s beaten this horse, but we need to wash our hands well. This includes washing hands before and after whatever we’re doing. I’d even wash your hands before and after going to the restroom. The alcohol-based hand sanitizers are good, but we don’t want to overuse them because they dry out your skin and you don’t want to break that down because it’s an important layer of defense.

Hard, nonporous surfaces that get touched a lot should be wiped down at least once daily. In doctor’s offices, that should be once every hour or two. There’s a lot of transmission from those surfaces. If you’re a physician and have an N-95 mask, have it re-fitted for you. And don’t touch your face, or at least wash your hands before you do.

What have you been recommending patients do, outside of washing their hands?

DOs have a tradition of helping support the body’s self-healing mechanisms. The immune system is critically important, and many patients can keep it healthy by getting the sleep they need, eating the right amount of vegetables and fruits, and exercising and getting plenty of fresh air. We can all also take time to relax and try to reduce stress and panic.

There is a constant flood of information on this pandemic. Where are you getting the news you need to stay up to date?

I’m looking at the WHO and the CDC websites to get the real numbers, and then the major news outlets to get a sense for what my patients are going to be asking me about.

We’re at a huge inflection point with the number of cases in the U.S., and while I know it’s still small, it looks exponential. Part of that is awareness and improved access to testing and the ability to test more people with mild symptoms.

What do you think the future of COVID-19 will look like, both for the profession and the world?

It’s hard to say. There could be seasonal variation, so that would mean that come May, it would start to wane. The problem with that would be, when our summer comes, it would migrate to the southern hemisphere and come back here in the fall. Another possibility is a massive spike to the point that half the globe is infected, and if many people develop immunity, it’ll burn itself out. But we’ve gotten some reports of the virus reinfecting people. It’s small numbers, but they’re there.

The best-case scenario is that it burns out in the summer and goes away, which probably won’t happen. Another best-case is that it doesn’t have seasonal variation and it’s just a slow, steady increase, and we figure out what to do, which buys us more time. I pray that I’m wrong, but it looks like it’ll get out of hand. We’ll learn a lot in the next couple weeks.

I’m really proud of the way the medical profession is handling this. Based on everything I’ve heard, most doctors are trying to promote a middle of the road, accurate depiction of what we know and don’t know.

Ray L. Morrison, DO FACOS

Always remember the effectiveness of Osteopathic techniques. The “lymphatic pump” technique can be utilized and even taught to our patients and could have a significant effect in the healing process. They didn’t look at preemptive studies prior to the Spanish Flu and had significant results.

David Redding

I agree, and the most important lymphatic pump is the “abdominal Pump” which can be self administered by placing one of your fist on your abdomen and then the other hand over it and performing the pumping action for about 3 to 4 minutes.

David Redding

Not enough is being said about how to boost one’s own immunity. It looks like all will be exposed at some point so what can be done to improve one’s natural defenses against viruses in general; like drinking plenty of water, removing sweets from one’s diet, eating plenty of immune boosters like, vegetables, fruits, oranges; not over eating and eating slowly.

Joziah Abadash

excellent point, easily overlooked considering that almost all those recovered or asymptomatic but positive experience mild flu-like symptoms that last 1-2 weeks. So, since viral pathogens are only as strong as our immune systems are weak- this should be the first line of defense, then of course personal hygiene and keeping suitable distance. The reality is though, since it is a virus, since there are obviously carriers or hosts, and there isn’t necessarily a way to identify asymptomatics, what we should be saying is : what can I do for my body now, to prepare for when I am exposed? I am guessing that strengthening the immune system isn’t on the discussion table because no one wants to be at the mercy of being called out by the pharmaceutical corporations who are bound and determined to force vaccinations and those medical associations whom they have much control over. Thank you David. PS. I have read much on immune system strengthening on Green Med Info Website , Dr. Weil’s website, Dr Mercola’s website and many others- the info is out there, just shut of the news and those who are so narrow-minded they have forgotten the basics of human health.

Jeffrey Williams, DO FACOS

William Kirmes DO

Rib raising by osteopathic physicians during the pandemic of 1918 saved a lot of lives. Today these techniques are probably used only by respiratory therapists and very few physicians. Those techniques still work but many may be hesitant to get close and personal with patients who have the virus.